Provider Demographics
NPI:1144929969
Name:NELSON, MADELEINE
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 KELLY JOHNSON BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3947
Mailing Address - Country:US
Mailing Address - Phone:719-726-6573
Mailing Address - Fax:719-771-0460
Practice Address - Street 1:1465 KELLY JOHNSON BLVD STE 310
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3947
Practice Address - Country:US
Practice Address - Phone:719-726-6573
Practice Address - Fax:719-771-0460
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant